PKG00247481-instructions.pdf

U.S. Department of Health and Human Services

Bureau of Primary Health Care Health Center Program

New Access Points

Funding Opportunity Number: HRSA-19-080

Funding Opportunity Type(s): New and Competing Supplement/Revision Catalog of Federal Domestic Assistance (CFDA) Number: 93.224

NOTICE OF FUNDING OPPORTUNITY

Fiscal Year 2019

Application Due Date in Grants.gov: March 12, 2019 Supplemental Information Due Date in HRSA EHBs: April 11, 2019

Ensure your SAM and Grants.gov registrations and passwords are current immediately!

HRSA will not approve deadline extensions for lack of registration.

Registration in all systems, including SAM.gov, Grants.gov and HRSA EHBs, may take up to 1 month to complete.

Issuance Date: January 11, 2019

Allison Arnone Public Health Analyst, Bureau of Primary Health Care Office of Policy and Program Development Contact: https://www.hrsa.gov/about/contact/bphc.aspx Telephone: (301) 594-4300 NAP Technical Assistance website:

http://bphc.hrsa.gov/programopportunities/fundingopportunities/NAP/index.html

Authority: Public Health Service Act, Section 330, as amended (42 U.S.C. 254b, as amended) https://www.hrsa.gov/about/contact/bphc.aspx

HRSA-19-080 i

EXECUTIVE SUMMARY

The Health Resources and Services Administration (HRSA) is accepting applications for fiscal year (FY) 2019 Health Center Program New Access Points (NAP). The purpose of this funding is to provide operational support for new service delivery sites under the Health Center Program to improve the health of the nation’s underserved communities and vulnerable populations by expanding access to affordable, accessible, quality, and cost effective primary health care services.

Funding Opportunity Title: New Access Points (NAP) Funding Opportunity Number: HRSA-19-080 Due Date for Applications – Grants.gov:

March 12, 2019 (11:59 p.m. ET)

Due Date for Supplemental Information – HRSA EHBs:

April 11, 2019 (5 p.m. ET)

Anticipated Total Annual Available FY 2019 Funding:

$50,000,000

Estimated Number and Type of Awards: Approximately 75 grants Estimated Award Amount: Up to $650,000 per year subject to the availability of appropriated funds Cost Sharing/Match Required: No Project Period/Period of Performance: September 1, 2019 through

August 31, 2021 (up to 2 years) Eligible Applicants: Domestic public or private nonprofit entities, including tribal organizations.

See Section III of this notice of funding opportunity (NOFO) for complete eligibility information.

Application Guide

You (the applicant organization/agency) are responsible for reading and complying with the instructions included in HRSA’s SF-424 Two-Tier Application Guide, available online at http://www.hrsa.gov/grants/apply/applicationguide/sf424programspecificappguide.pdf.

Technical Assistance

HRSA will hold a pre-application technical assistance (TA) webinar for applicants seeking funding through this opportunity. The webinar will provide an overview of pertinent information in the NOFO and an opportunity for applicants to ask questions.

Visit the NAP Technical Assistance website for webinar details, frequently asked questions, sample documents, and additional resources.

http://www.hrsa.gov/grants/apply/applicationguide/sf424programspecificappguide.pdf

HRSA-19-080 ii

The HRSA Primary Health Care Digest is a weekly email newsletter containing information and updates pertaining to the Health Center Program, including competitive funding opportunities. Organizations interested in seeking funding under the Health Center Program are encouraged to have several staff subscribe at https://public.govdelivery.com/accounts/USHHSHRSA/subscriber/new?topic_id=USHH

SHRSA_118.

Throughout the application development and preparation process, you are encouraged to work with Primary Care Associations (PCAs), National Cooperative Agreement recipients (NCAs), and/or Primary Care Offices (PCOs) to prepare a responsive application. For a listing of HRSA-supported PCAs and NCAs, refer to HRSA’s Strategic Partnerships website. For a list of PCO contacts, refer to https://bhw.hrsa.gov/shortage-designation/hpsa/primary-care-offices.

Summary of Key Changes since the FY 2017 NAP Funding Opportunity

• Health Center Program requirements are detailed in the Health Center Program Compliance Manual (Compliance Manual).

• The page limit has been reduced from 200 pages to 175 pages. See Section IV.2 for additional information.

• The Project Narrative has been streamlined to reduce applicant burden, simplify the collection of information, and more closely align with Health Center Program requirements as detailed in the Compliance Manual.

• In making funding decisions, HRSA may consider such factors as your current and proposed service area boundaries, the extent to which the proposed service area is currently served by the Health Center Program, unmet need, and collaboration. For example, if your proposed NAP site is within one-half mile of another health center service delivery site or if your proposed service area does not have relevant/rational boundaries, HRSA may opt not to award funds for your NAP application. See Section V.2 for additional information.

• NAP funding will not be awarded to a current Health Center Program award recipient that has 1 or more 60- or 30-day conditions on their award at the time that HRSA issues awards under this NOFO.

• The project director (PD)/chief executive officer (CEO) must be a direct employee of the health center.

• You must consult with appropriate State and local government agencies and health care providers regarding the need for services at the proposed NAP site and attest to this consultation on the Summary Page form.

• Form 1C: Documents on File has been streamlined and edited to align with Compliance Manual.

• The Need for Assistance Worksheet (Form 9) has been replaced by the Service Area Needs Assessment Methodology (SANAM) which will be used to calculate an Unmet Need Score (UNS) for each proposed service area. See the Funding Requirements section for more information.

• A question on the use of telehealth has been added to the Project Narrative RESOURCES/CAPABILITIES section.

https://public.govdelivery.com/accounts/USHHSHRSA/subscriber/new?topic_id=USHHSHRSA_118 https://public.govdelivery.com/accounts/USHHSHRSA/subscriber/new?topic_id=USHHSHRSA_118 https://bphc.hrsa.gov/qualityimprovement/strategicpartnerships/ https://bhw.hrsa.gov/shortage-designation/hpsa/primary-care-offices https://bphc.hrsa.gov/programrequirements/compliancemanual/introduction.html https://bphc.hrsa.gov/programrequirements/compliancemanual/introduction.html https://bphc.hrsa.gov/programrequirements/compliancemanual/index.html https://bphc.hrsa.gov/programrequirements/compliancemanual/introduction.html

HRSA-19-080 iii

• Scoring points have been adjusted from 5 to 10 for Evaluative Measures and from 10 to 5 for the Support Requested Review Criteria.

• The funding priority for unserved, high poverty populations has been replaced by a funding priority for locating proposed sites in “hot spot” zip codes, which are zip codes with high levels of unmet need. See Section V.2 for additional information.

• New applicants for NAP funding (but not look-alikes that have been found to be fully compliant with Health Center Program requirements) will be awarded a 1-year project period.

• If you are a new applicant or a look-alike with unresolved conditions on your Notice of Look-alike Designation related to Health Center Program requirements, you will be required to submit a Compliance Achievement Plan within 120 days of Notice of Award.

Other Federal Benefits

Receipt of Health Center Program funds, while a basis for eligibility, does not automatically confer such associated federal benefits as Federal Tort Claims Act (FTCA) coverage, 340B Drug Pricing Program participation, National Health Service Corps participation, or Federally Qualified Health Center (FQHC) reimbursement.

Eligibility for such benefits depends upon compliance with applicable requirements in addition to the award of Health Center Program funding, including the submission and approval of separate applications to appropriate approval authorities. Please note, in this regard, that the Centers for Medicare & Medicaid Services manages FQHC reimbursement (see https://www.cms.gov/Center/Provider-Type/Federally-Qualified- Health-Centers-FQHC-Center.html). More information about the FTCA Health Center Program and the 340B Drug Pricing Program is available in the Other Information section.

https://www.cms.gov/Center/Provider-Type/Federally-Qualified-Health-Centers-FQHC-Center.html https://www.cms.gov/Center/Provider-Type/Federally-Qualified-Health-Centers-FQHC-Center.html

HRSA-19-080 iv

Table of Contents

I. PROGRAM FUNDING OPPORTUNITY DESCRIPTION

1. PURPOSE

2. BACKGROUND

II. AWARD INFORMATION

1. TYPE OF APPLICATION AND AWARD

2. SUMMARY OF FUNDING

III. ELIGIBILITY INFORMATION

1. ELIGIBLE APPLICANTS

2. COST SHARING/MATCHING

3. OTHER

IV. APPLICATION AND SUBMISSION INFORMATION

1. ADDRESS TO REQUEST APPLICATION PACKAGE

2. CONTENT AND FORM OF APPLICATION SUBMISSION

i. Project Abstract (Submit in Grants.gov)

ii. Project Narrative (Submit in HRSA EHBs – required for completeness)

iii. Budget (Submit in HRSA EHBs)

iv. Budget Narrative (Submit in HRSA EHBs)

v. Program-Specific Forms (Submit in HRSA EHBs)

vi. Attachments (Submit in HRSA EHBs)

3. DUN AND BRADSTREET DATA UNIVERSAL NUMBERING SYSTEM (DUNS) NUMBER AND

SYSTEM FOR AWARD MANAGEMENT

4. SUBMISSION DATES AND TIMES

5. INTERGOVERNMENTAL REVIEW

6. FUNDING RESTRICTIONS

V. APPLICATION REVIEW INFORMATION

1. REVIEW CRITERIA

2. REVIEW AND SELECTION PROCESS

3. ASSESSMENT OF RISK AND OTHER PRE-AWARD ACTIVITIES

4. ANTICIPATED ANNOUNCEMENT AND AWARD DATES

VI. AWARD ADMINISTRATION INFORMATION

1. AWARD NOTICES

2. ADMINISTRATIVE AND NATIONAL POLICY REQUIREMENTS

3. REPORTING

VII. AGENCY CONTACTS

VIII. OTHER INFORMATION

APPENDIX A: PROGRAM-SPECIFIC FORMS INSTRUCTIONS

APPENDIX B: PERFORMANCE MEASURES INSTRUCTIONS

APPENDIX C: OPERATIONAL PLAN

APPENDIX D: ONE-TIME FUNDING REQUEST INFORMATION

HRSA-19-080 1

I. Program Funding Opportunity Description

1. Purpose

This notice announces the opportunity to apply for Fiscal Year (FY) 2019 New Access Points (NAP) funding under the Health Center Program. The purpose of this funding is to provide operational support for new service delivery sites to improve the health of the nation’s underserved communities and vulnerable populations by expanding access to affordable, accessible, quality, and cost effective primary health care services.

For the purposes of this notice of funding opportunity (NOFO), a Health Center Program new access point is a new, full-time, permanent service delivery site for the provision of comprehensive primary health care services to underserved populations. New access points improve the health status and decrease health disparities of medically underserved and vulnerable populations and address barriers to affordable and accessible primary health care services for a specific population and/or community.

Applicants may submit a request for federal support to establish a single new access point or multiple access points in a single NAP application, with the understanding that all proposed access points must be open and operational within 120 days of the Notice of Award.

For the purposes of this document, the term “health center” refers to all health centers for which funding is awarded under the following PHS Act subsections: Community Health Center (CHC – section 330(e)), Migrant Health Center (MHC – section 330(g)), Health Care for the Homeless (HCH – section 330(h)), and Public Housing Primary Care (PHPC – section 330(i)). Applicants may request funding to serve one or multiple population types (i.e., CHC, MHC, HCH, PHPC) within a single application (e.g., if you propose to serve both the general community and homeless individuals, you can submit a NAP application requesting both CHC and HCH funding).

2. Background

This program is authorized by section 330 of the Public Health Service (PHS) Act, as amended (42 U.S.C. 254b, as amended).

Health Center Program funding targets the nation’s high need geographic areas and populations by supporting nearly 1,400 health centers that operate more than 11,000 service delivery sites in every state, the District of Columbia, Puerto Rico, the Virgin Islands, and the Pacific Basin. In 2017, HRSA-funded health centers delivered accessible, affordable, quality primary health care services to more than 27 million people.

NAP applications may be submitted by new organizations (new applicants) or by health centers currently receiving Health Center Program operational funding (satellite applicants):

• A NEW applicant is an organization that is not currently a direct recipient of operational funding under the Health Center Program (authorized by section http://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section254b&num=0&edition=prelim

HRSA-19-080 2

330(e), (g), (h) and/or (i) of the PHS Act). A new application should address the entire scope of the project being proposed for NAP funding. A new applicant can be:

o A current Health Center Program look-alike;

o An organization that is operational at the time of application; or o An organization that proposes to become operational within 120 days of the Notice of Award.

Health Center Program look-alikes can propose NAP sites that are currently in or out of scope, however, HRSA will not award funding that would result in “dual status” whereby the organization would become both a Federal awardee under section 330 and a look-alike designee. Therefore, look-alike applicants must include all currently-approved look-alike sites as part of their FY 2019 NAP application (i.e., list all sites on Form 5B: Service Delivery Sites).

• A SATELLITE applicant is an organization that is currently receiving direct operational funding under the Health Center Program (H80 grant funding).1 A satellite application should address ONLY the proposed new access point (i.e., only the new site(s) and service area/target population proposed) in terms of need, population to be served, and the proposed health service delivery system.

Funding Requirements

Your application must document a high level of unmet need for primary health care services in the service area, with data to support the level of unmet need gathered through multiple sources including consultation with appropriate State and local government agencies and health care providers.

In recent past NAP funding opportunities, you were required to demonstrate a quantitative measure of need for primary health care services through the completion of the Need for Assistance Worksheet. For the FY 2019 NAP funding opportunity, HRSA will use the Service Area Needs Assessment Methodology (SANAM), a standardized assessment of need for primary care services, to automatically generate an unmet need score (UNS) for your NAP application. The SANAM leverages public data sources on critical health determinants and calculates an UNS for every zip code.2 The UNS for each service area zip code proposed in the application (on Form 5B: Service Sites) is combined to establish the overall UNS for the application. The UNS accounts for up to 20 points in the NEED section of the application score and is a factor in one of the funding priorities. More information on SANAM and UNS can be found on the NAP Technical Assistance website. The UNS builds on the Medically Underserved Area and

1 If any current Health Center Program award recipient incorrectly applies as a new applicant, the applicant type will be changed to satellite in the system, which may delay access to the application in HRSA EHBs.

2 To calculate the UNS, HRSA uses Zip Code Tabulation Areas (ZCTAs). Each ZCTA is associated with one or more zip codes.

HRSA-19-080 3

Medically Underserved Population designations as an objective assessment of unmet need.

In addition to the UNS, applicants have the opportunity to further describe the unique access issues experienced by their target population in the Project Narrative and propose a comprehensive plan to meet this need. You must also describe collaborative and coordinated delivery systems for the provision of quality health care to the underserved. In addition, you must ensure the availability and accessibility of primary health care services to all individuals in the service area and target population regardless of ability to pay.

You must demonstrate how your proposed service area has relevant and rational boundaries in relation to the existing service area (e.g., reasonable distance to other sites in scope, a size that ensures that services are accessible to the service area population, boundaries that conform to relevant boundaries of political subdivisions).

Your application must demonstrate compliance or plans to achieve compliance with Health Center Program requirements, as set forth in section 330 of the PHS Act and applicable program and grants regulations and as further detailed in the Compliance Manual. If funded, HRSA will assess your compliance during an Operational Site Visit conducted approximately 120 days after award for new applicants and mid-project period for satellite applicants. Failure to demonstrate compliance with Health Center Program requirements during the site visit will result in the placement of a condition of award, which provides a time-phased approach for resolution of an identified area of noncompliance.3 See Project Period and Compliance Status in Section V.2 for information about the impact of conditions on funding decisions and/or project period.

In addition to the Health Center Program requirements, specific requirements for applicants requesting funding under each population type are outlined below.

COMMUNITY HEALTH CENTER (CHC) APPLICANTS:

• Ensure compliance with PHS Act section 330(e) and program regulations, requirements, and policies.

• Provide a plan that ensures the availability and accessibility of required primary health care services to underserved populations in the service area.

MIGRANT HEALTH CENTER (MHC) APPLICANTS:

• Ensure compliance with PHS Act section 330(g); and, as applicable, section 330(e), program regulations, requirements, and policies.

• Provide a plan that ensures the availability and accessibility of required primary health care services to migratory and seasonal agricultural workers and their families in the service area, which includes:

o Migratory agricultural workers who are individuals whose principal employment is in agriculture, and who have been so employed within the last 24 months, and who establish for the purposes of such employment a temporary abode;

3 See Chapter 2: Health Center Program Oversight of the Compliance Manual.

https://bphc.hrsa.gov/programrequirements/compliancemanual/introduction.html https://bphc.hrsa.gov/programrequirements/compliancemanual/chapter-2.html

HRSA-19-080 4

o Seasonal agricultural workers who are individuals whose principal employment is in agriculture on a seasonal basis and who do not meet the definition of a migratory agricultural worker;

o Individuals who are no longer employed in migratory or seasonal agriculture because of age or disability who are within such catchment area; and/or o Family members of the individuals described above.

Note: Agriculture refers to farming in all its branches, as defined by the North American Industry Classification System under codes 111, 112, 1151, and 1152 (48

CFR § 219.303).

HEALTH CARE FOR THE HOMELESS (HCH) APPLICANTS:

• Ensure compliance with PHS Act section 330(h); and, as applicable, section 330(e), program regulations, requirements, and policies.

• Provide a plan that ensures the availability and accessibility of required primary health care services to individuals:

o Who lack housing (without regard to whether the individual is a member of a family);

o Whose primary residence during the night is a supervised public or private facility that provides temporary living accommodations;

o Who reside in transitional housing;

o Who reside in permanent supportive housing or other housing programs that are targeted to homeless populations; and/or o Who are children and youth at risk of homelessness, homeless veterans, and veterans at risk of homelessness.

• Provide substance use disorder services.

PUBLIC HOUSING PRIMARY CARE APPLICANTS (PHPC):

• Ensure compliance with PHS Act section 330(i); and, as applicable, section 330(e), program regulations, requirements, and policies.

• Provide a plan that ensures the availability and accessibility of required primary health care services to residents of public housing and individuals living in areas immediately accessible to public housing. Public housing includes public housing agency-developed, owned, or assisted low-income housing, including mixed finance projects, but excluding housing units with no public housing agency support other than Section 8 housing vouchers.

• Consult with residents of the proposed public housing sites regarding the planning and administration of the program.

You must demonstrate readiness to initiate NAP site operations. Within 120 days of the Notice of Award, all proposed sites (as noted on Form 5B: Service Sites and described in the Project Narrative) must have the necessary staff and providers in place to begin operating and delivering services to the proposed target population as outlined in Attachment 12: Operational Plan. Failure to verify that all sites are operational within 120 days of the Notice of Award will result in the placement of a condition of award, which provides a time-phased approach for resolution. If you fail to successfully resolve

HRSA-19-080 5

a site-related condition within the specified timeframes, HRSA may withdraw support through termination of all, or part, of the NAP award per 45 CFR § 75.371.

You must provide a realistic and achievable number of unduplicated patients projected to be served in 2020 on Form 1A: General Information Worksheet. If you do not serve at least the number of patients projected to be served in 2020, funding for the service area may be reduced when it is next competed through a Service Area Competition.4

II. Award Information

1) Type of Application and Award

Types of applications sought:

• New

• Competing Supplement/Revision (i.e., satellite)

HRSA will provide funding in the form of a grant.

2) Summary of Funding

HRSA expects approximately $50,000,000 to be available annually to fund 75 recipients. Of this total, approximately:

• $40,750,000 is expected to be available for section 330(e) - CHC applicants,

• $4,300,000 for section 330(g) – MHC applicants,

• $4,350,000 for section 330(h) – HCH applicants, and

• $600,000 for section 330(i) – PHPC applicants.

You may apply for a ceiling amount of up to $650,000 total costs (includes both direct and indirect costs) per year. Of the $650,000, you may request Health Center Program funding up to $150,000 in Year 1 only for one-time minor capital costs for equipment and/or minor alteration/renovation (see Appendix D). This funding opportunity does not support construction costs.

The project period is September 1, 2019 through August 31, 2021 (2 years). New applicants for NAP funding (but not look-alikes that have been found to be fully compliant with Health Center Program requirements) will be awarded a 1-year project period. See Project Period and Compliance Status in Section V.2 for more information.

Funding beyond the first year is subject to the availability of appropriated funds for the Health Center Program in subsequent fiscal years, satisfactory recipient performance, and a decision that continued funding is in the best interest of the Federal Government.

4 If a health center is unable to meet the total unduplicated patient projection in calendar year 2020 (the patient projection from this application, in addition to other patient projections from funded supplemental applications), funding for the service area may be reduced when the service area is next competed through Service Area Competition. Therefore, your 2020 patient projection must be realistic and achievable. For more information, see the Patient Target FAQs.

http://www.ecfr.gov/cgi-bin/retrieveECFR?gp=1&SID=4d52364ec83fab994c665943dadf9cf7&ty=HTML&h=L&r=PART&n=pt45.1.75 http://bphc.hrsa.gov/programopportunities/fundingopportunities/sac/patienttarget.pdf

HRSA-19-080 6

All HRSA awards are subject to the Uniform Administrative Requirements, Cost Principles and Audit Requirements at 45 CFR part 75.

III. Eligibility Information

1. Eligible Applicants

1) Your organization must be a domestic public5 or private, nonprofit entity, as demonstrated in Attachment 11: Evidence of Nonprofit or Public Center Status.

Tribes, tribal organizations, faith-based organizations, and community-based organizations are eligible to apply.6

2) Your organization must provide health services to medically underserved populations, as defined in section 330 of the PHS Act. You may not propose to serve ONLY a single age group, address a single health issue/disease category, or provide any subset of the required primary health care services.7 You must propose a new access point project (across all proposed sites) that provides comprehensive primary medical care as its main purpose as documented on:

a) Form 1A: General Information Worksheet (number of projected medical patients is greater than projected patients for other service types, e.g., mental health, dental) and

b) Form 5A: Services Provided (General Primary Medical Care is provided directly (Column I) and/or through formal written contractual agreements in which the health center pays for the service (Column II)).

3) You must ensure the required primary health care services will be available and accessible in the service area. As such, you must propose at least one permanent service delivery site8 that provides comprehensive primary medical care as its main purpose and operates for a minimum of 40 hours per week, as documented on Form 5B: Service Sites. If you propose to serve only migratory and seasonal agricultural workers, you may propose a full-time seasonal (rather than permanent) service delivery site.

a) A permanent site is a fixed building location that operates year-round.

5 Only public agency health centers can have a co-applicant. A co-applicant is the established body, identified as such in the NAP application, that provides and functions as the health center’s governing board when the public agency determines that it cannot meet the Health Center Program governing board requirements directly (Section 330(r)(2)(A) of the Public Health Service Act). However, this status does not confer any right to receive grant funding or any other grant-associated federal benefits upon the co-applicant organization.

6 Refer to Chapter 1: Health Center Program Eligibility of the Compliance Manual.

7 Refer to the Service Descriptors for Form 5A: Services Provided, available at https://bphc.hrsa.gov/sites/default/files/bphc/programrequirements/scope/form5aservicedescriptors.pdf, for details regarding required primary health care services.

8 See Policy Information Notice 2008-01: Defining Scope of Project and Policy for Requesting Changes, available at http://bphc.hrsa.gov/programrequirements/scope.html, which describes and defines the term “service sites.”

http://www.ecfr.gov/cgi-bin/retrieveECFR?gp=1&SID=4d52364ec83fab994c665943dadf9cf7&ty=HTML&h=L&r=PART&n=pt45.1.75 https://bphc.hrsa.gov/programrequirements/compliancemanual/chapter-1.html https://bphc.hrsa.gov/programrequirements/compliancemanual/introduction.html https://bphc.hrsa.gov/sites/default/files/bphc/programrequirements/scope/form5aservicedescriptors.pdf http://bphc.hrsa.gov/programrequirements/scope.html

HRSA-19-080 7

b) You must provide a verifiable street address for each proposed site on Form 5B:

Service Sites.

c) You may propose a mobile medical unit only if you also propose at least one full-time, fixed site in the application and on Form 5B: Service Sites.

d) You may propose a school-based service delivery site if the site is a permanent, full time site or if you propose it in addition to a permanent, full time site, and you demonstrate in the RESPONSE section of the Project Narrative how the health center will ensure that the entire underserved population in the service area has access to all required services.

4) Your proposed service delivery site(s), based on Form 5B: Service Sites, must be located in an area with a shortage of health services. All proposed NAP sites must:

a) Not be located in the same building as any site already in the approved scope of project of any Health Center Program award recipient or look-alike,9

• With the exception of look-alike applicants that include their own look-alike sites as part of their FY 2019 NAP application,10

• Including those sites pending verification via Change in Scope or capital development awards (e.g., Capital Development, Building Capacity, Health Infrastructure Investment Program);

b) Not represent the relocation or consolidation of currently approved sites; and

c) Not be proposed through an active Change in Scope request or Health Center

Program (H80) funding opportunity application at the time of application.

5) NEW APPLICANTS ONLY: You must propose to serve a defined geographic area that is federally-designated, in whole or in part, as a Medically Underserved Area (MUA) or Medically Underserved Population (MUP).11 If the area is not currently federally-designated as an MUA or MUP, you must provide documentation that a request for designation has been submitted and designation must be received prior to award. Note: If you are requesting funding only for MHC, HCH, and/or PHPC, you are not required to have a MUA/MUP designation for the proposed service area and/or target population. See Section I.1 for definitions of the MHC, HCH, and PHPC populations.

6) PUBLIC HOUSING PRIMARY CARE APPLICANTS ONLY: If you are applying for 330(i) funding, you must demonstrate that you have consulted with the public housing residents in the preparation of the NAP application and will ensure ongoing consultation with the residents regarding the planning and administration of the health center, as documented in the GOVERNANCE section of the Project Narrative.

9 Tools are available to assist you in determining current Health Center Program service sites in your proposed service area, including the UDS Mapper (http://www.udsmapper.org) and Find a Health Center (http://findahealthcenter.hrsa.gov).

10 A current Health Center Program look-alike may propose a new site(s) in addition to their current site(s) in scope, as desired.

11 To find out if all or part of your service area is located in a designated MUA/MUP, see https://data.hrsa.gov/tools/shortage-area/mua-find.

http://www.udsmapper.org/ http://findahealthcenter.hrsa.gov/ https://data.hrsa.gov/tools/shortage-area/mua-find

HRSA-19-080 8

2. Cost Sharing/Matching

Cost sharing/matching is not required for this program.

However, under 42 CFR § 51c.104 and 42 CFR § 51c.303(r), HRSA will take into consideration whether and to what extent you present evidence that:

• You have made efforts to secure financial and professional assistance and support for the project within the proposed service area.

• You will utilize, to the maximum extent feasible, other federal, state, local, and private resources available for support of the project.

3. Other

HRSA will consider any application that exceeds the ceiling amount of $650,000 on the SF-424A non-responsive and will not consider it for funding under this notice.

HRSA will consider any application that fails to satisfy the deadline requirements referenced in Section IV.4 non-responsive and will not consider it for funding under this notice.

Applications in which the applicant organization (as listed on the SF-424) does not propose to perform a substantive role in the project will be considered non-responsive and will not be considered for funding under this notice.12

If you do not include all documents indicated as “required for completeness” in Section IV.2.ii and Section IV.2.vi in your application, HRSA will consider your application to be non-responsive and will not consider it for funding under this notice. This includes the Project Narrative, as well as Attachments 2: Bylaws, 6: Co-Applicant Agreement, 10:

Articles of Incorporation, and 11: Evidence of Nonprofit or Public Center Status.

NOTE: Multiple applications from an organization are not allowable.

HRSA will only accept your first validated electronic submission, under the correct funding opportunity number, in Grants.gov.13 Applications submitted after the first submission will be marked as duplicates and considered ineligible for review. If you want to change information submitted in a Grants.gov application, you may do so in the HRSA Electronic Handbooks (HRSA EHBs) application phase.

12 Applications in which the applicant organization proposes to perform a substantive role in the project in addition to conducting a portion of the project through a subrecipient arrangement are allowable.

13 Grants.gov has compatibility issues with Adobe Reader DC. Direct questions pertaining to software compatibility to Grants.gov. See Section VII for contact information.

http://www.ecfr.gov/cgi-bin/text-idx?node=42:1.0.1.4.27&rgn=div5 http://www.ecfr.gov/cgi-bin/text-idx?node=42:1.0.1.4.27&rgn=div5

HRSA-19-080 9

IV. Application and Submission Information

1. Address to Request Application Package

HRSA requires you to apply electronically through Grants.gov and the HRSA EHBs.

You must use a two-phase submission process associated with this NOFO and follow the directions provided at http://www.grants.gov/applicants/apply-for-grants.html and in HRSA EHBs.

• Phase 1 – Grants.gov – Required information must be submitted and validated via Grants.gov with a due date of March 12, 2019 at 11:59 p.m. Eastern Time;

and

• Phase 2 – HRSA EHBs – Supplemental information must be submitted via HRSA EHBs with a due date of April 11, 2019 at 5 p.m. Eastern Time.

Only applicants who successfully submit the workspace application package associated with this NOFO in Grants.Gov (Phase 1) by the due date may submit the required additional information in HRSA EHBs (Phase 2).

The NOFO is also known as “Instructions” on Grants.gov. If you provide your email address when reviewing or preparing the workspace application package, you will automatically be notified in the event HRSA changes and/or republishes the NOFO on Grants.gov before its closing date. Responding to an earlier version of a modified notice may result in a less competitive or ineligible application. Please note you are ultimately responsible for reviewing the For Applicants page for all information relevant to desired opportunities.

2. Content and Form of Application Submission

Application Format Requirements Section 5 of HRSA’s SF-424 Two-Tier Application Guide provides instructions for the budget, budget narrative, staffing plan and personnel requirements, assurances, certifications, and abstract. You must submit the information outlined in the Application Guide in addition to the program-specific information below. You are responsible for reading and complying with the instructions included in HRSA’s SF-424 Two-Tier Application Guide except where instructed in the NOFO to do otherwise. You must submit the application in English and in the terms of U.S. dollars (45 CFR § 75.111(a)).

You must submit the following application components in Grants.gov:

• Application for Federal Assistance (SF-424)

• Project Abstract (attached under box 15 of the SF-424)

• Assurances for Non-Construction Programs (SF-424B)

• Project/Performance Site Locations

• Grants.gov Lobbying Form

• Key Contacts http://www.grants.gov/applicants/apply-for-grants.html https://www.grants.gov/web/grants/applicants.html http://www.hrsa.gov/grants/apply/applicationguide/sf424programspecificappguide.pdf

HRSA-19-080 10

You must submit the following application components in HRSA EHBs:

• Project Narrative

• Budget Information – Non-Construction Programs (SF-424A)

• Budget Narrative

• Program-Specific Forms

• Attachments

See Section 9.5 of the Application Guide for the Application Completeness Checklist.

Application Page Limit The total size of all uploaded files may not exceed the equivalent of 175 pages when printed by HRSA. The page limit includes the abstract, project and budget narratives, attachments, and letters of commitment and support. Standard OMB-approved forms that are included in the workspace application package do not count in the page limit.

Indirect Cost Rate Agreement and proof of nonprofit status (if applicable) do not count in the page limit. We strongly urge you to take appropriate measures to ensure your application does not exceed the specified page limit.

Applications must be complete, within the specified page limit, validated by Grants.gov, and submitted under the correct funding opportunity number prior to the Grants.gov and HRSA EHBs deadlines to be considered under this notice.

Debarment, Suspension, Ineligibility, and Voluntary Exclusion Certification

1) The prospective recipient certifies, by submission of this proposal, that neither it nor its principals is presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participation in this transaction by any federal department or agency.

2) Failure to make required disclosures can result in any of the remedies described in 45 CFR § 75.371, including suspension or debarment. (See also 2 CFR parts 180 and 376, and 31 U.S.C. 3321).

3) Where the prospective recipient is unable to attest to the statements in this certification, an explanation shall be included in Attachment 14: Other Relevant Documents.

See Section 5.1 viii of HRSA’s SF-424 Two-Tier Application Guide for additional information on all certifications.

Program-Specific Instructions In addition to application requirements and instructions in Sections 4 and 5 of HRSA’s SF-424 Two-Tier Application Guide (including the budget, budget narrative, staffing plan and personnel requirements, assurances, certifications, and abstract), include the following:

Application for Federal Assistance SF-424 (Submit in Grants.gov) In addition to the specific fields below, see Section 3.2 of HRSA’s SF-424 Two-Tier Application Guide.

http://www.hrsa.gov/grants/apply/applicationguide/sf424programspecificappguide.pdf http://www.hrsa.gov/grants/apply/applicationguide/sf424programspecificappguide.pdf http://www.hrsa.gov/grants/apply/applicationguide/sf424programspecificappguide.pdf https://www.hrsa.gov/sites/default/files/hrsa/grants/apply/applicationguide/sf-424-program-specific-app-guide.pdf https://www.hrsa.gov/sites/default/files/hrsa/grants/apply/applicationguide/sf-424-program-specific-app-guide.pdf

HRSA-19-080 11

• Box 2: Type of Applicant: Incorrect selection may delay HRSA EHBs access.

o New – Organization not currently funded through the Health Center

Program: Select “New” and leave box 4 blank.

o Satellite – Current Health Center Program award recipient applying to serve a new service area: Check the “Revision” box, select “Other” and type “Supplement” and your H80 grant number in box 4.

• Box 5b: Federal Award Identifier: 10-digit number starting with H80 or LAL for current health centers. New applicants should leave this blank.

i. Project Abstract (Submit in Grants.gov)

See Section 5.1.ix of HRSA’s SF-424 Two-Tier Application Guide.

In addition, the abstract must provide:

• A brief overview of the organization, the community to be served, and the target population.

• A description of how the proposed project will address the need for comprehensive primary health care services in the community and target population.

• The number of proposed new patients, visits, and providers; proposed service delivery sites and locations; and services to be provided.

ii. Project Narrative *(Submit in HRSA EHBs – required for completeness)

This section provides a comprehensive description of all aspects of the proposed project.

It should be succinct, self-explanatory, consistent with forms and attachments, and well organized so that reviewers can understand the proposed project.

The Project Narrative must:

• Address the specific Project Narrative elements below, with the requested information appearing under the appropriate Project Narrative section header or the designated forms and attachments.

• Reference attachments and forms as needed. Referenced items must be part of the HRSA EHBs submission.

• Where applicable, demonstrate compliance with Health Center Program requirements, as detailed in the Compliance Manual.

• Reflect the NAP proposed scope of project (proposed services, providers, sites, service area zip codes, and target population). If you are a satellite applicant, you may refer to current services, policies, procedures, and capacity as they relate to the new access point project (e.g., transferrable experience, procedures, resources).

Use the following section headers for the narrative: Need, Response, Collaboration, Evaluative Measures, Resources/Capabilities, Governance, and Support Requested.

https://www.hrsa.gov/sites/default/files/hrsa/grants/apply/applicationguide/sf-424-program-specific-app-guide.pdf

HRSA-19-080 12

NEED – Corresponds to Section V.1 Review Criterion 1: NEED

Information provided in the NEED section must:

• Demonstrate compliance with the Needs Assessment Health Center Program requirement described in Chapter 3 of the Compliance Manual.

• Serve as the basis for, and align with, the activities and goals described throughout the application.

• Be utilized to inform and improve the delivery of health center services.

1) Describe your proposed service area (consistent with Attachment 1: Service Area

Map and Table), including:

a) The service area boundaries, including how they conform to relevant boundaries of political subdivisions, school districts, and Federal and State health and social service programs. If your proposed service area does not contain contiguous zip codes, or is not contiguous with your current health center service area (if applicable), explain why.

b) How the service area reflects where the proposed patients reside (e.g., service area zip codes listed on Form 5B: Service Sites represent those where 75 percent of proposed patients reside).

c) The extent to which the service area is currently served by the Health Center Program (reference the Health Center Program penetration percentages on the table provided in Attachment 1: Service Area Map and Table), including health center locations, proximity to your proposed service delivery site(s),14 and accessibility. If the proposed NAP site(s) serves an area already served in part by another health center, explain the remaining unmet need.

2) Describe, citing relevant data and their sources, the current unmet health care needs in the service area/target population, specifically addressing items a-e below. If you are requesting funding for one or more special populations (MHC, HCH, and/or PHPC),15 include the specific needs of each targeted special population. In your description of need for services in the proposed service area, you must include data informed by or gathered through consultation with appropriate State and local government agencies (e.g., health department, state Medicaid agency, state Primary Care Office) and data informed by or gathered through consultation with other health care providers.

a) The extent to which your target population is currently served by other primary health care providers (e.g., rural health clinics, critical access hospitals, private providers serving Medicaid patients) and the remaining unmet need.

b) Factors associated with access to care and health care utilization (e.g., geography, transportation, occupation, unemployment, income level, educational attainment, transient populations).

14 If your proposed NAP site is within one-half mile of another health center service delivery site, HRSA may opt not to award funds for your NAP application. See Section V.2 for additional information.

15 Special populations by type of health center are MHC – Migratory and Seasonal Agricultural Workers and Families, HCH – People Experiencing Homelessness, or PHPC – Residents of Public Housing.

https://bphc.hrsa.gov/programrequirements/compliancemanual/chapter-3.html

HRSA-19-080 13

c) Most significant causes of morbidity and mortality (e.g., diabetes, cardiovascular disease, cancer, low birth weight, mental health and/or substance use disorder).

d) Health disparities.

e) Unique health care needs or characteristics that impact health, access to care, or health care utilization (e.g., social factors, environmental factors, occupational factors, cultural/ethnic factors, language needs, housing status).

RESPONSE – Corresponds to Section V.1 Review Criterion 2: RESPONSE

Information provided in the RESPONSE section must demonstrate compliance with the Health Center Program requirements described in the following chapters of the Compliance Manual:

• Chapter 4: Required and Additional Health Services

• Chapter 6: Accessible Locations and Hours of Operation

• Chapter 7: Coverage for Medical Emergencies During and After Hours

• Chapter 8: Continuity of Care and Hospital Admitting

• Chapter 9: Sliding Fee Discount Program

1) On Form 1A: General Information Worksheet, under Unduplicated Patients and

Visits by Population Type, provide goals for the estimated new patients you project to serve in 2020 at your proposed NAP site(s). In the narrative, describe:

a) How you determined the projected number of patients, based on unmet need.

b) How the projected number of patients is achievable given any recent or anticipated changes in the local health care landscape, organizational structure, and/or workforce capacity.

c) The current number of patients and the increase in patients served, if the proposed NAP site(s) is currently operational (including Health Center Program look-alikes).

2) Describe how you will ensure access to all required services16 and any additional services (consistent with Form 5A: Services Provided) to meet identified unmet needs, including:

a) The method of provision of services, including whether services will be provided directly (Form 5A, Column I), through contracts or agreements for which the health center pays (Form 5A, Column II), or through formal referral arrangements (Form 5A, Column III) (consistent with Attachment 7: Summary of Contracts and Agreements).

b) How you will document services provided through contractual agreements (Form 5A, Column II) in the patient’s health center record, and how the health center will pay for the services.

c) How you will manage services provided through formal referral arrangements (Form 5A, Column III), and how you will establish a process for tracking and referring patients back to the health center for appropriate follow-up care.

d) How your enabling services (e.g., case management, outreach, eligibility assistance, health education, transportation, translation) will increase access to

16 Refer to Scope of Project, including the Column Descriptors for Form 5A: Services Provided.

https://bphc.hrsa.gov/programrequirements/compliancemanual/chapter-4.html https://bphc.hrsa.gov/programrequirements/compliancemanual/chapter-6.html https://bphc.hrsa.gov/programrequirements/compliancemanual/chapter-7.html https://bphc.hrsa.gov/programrequirements/compliancemanual/chapter-8.html https://bphc.hrsa.gov/programrequirements/compliancemanual/chapter-9.html http://bphc.hrsa.gov/programrequirements/scope.html https://bphc.hrsa.gov/sites/default/files/bphc/programrequirements/scope/form5acolumndescriptors.pdf

HRSA-19-080 14

care, particularly for the barriers to care identified in the NEED section and any targeted special populations.

e) How you will ensure that the entire underserved population (all individuals and age groups) in the service area will have access to all required services.

f) If you are requesting HCH funding: Document how substance use disorder services will be made available (consistent with Form 5A).

3) Describe plans to hire, contract, and/or establish formal referral arrangements with all providers and begin providing services at all sites (consistent with Forms 5A:

Services Provided and 5B: Service Sites) within 120 days of award.

4) Upload a detailed operational plan as Attachment 12: Operational Plan (see Appendix C). The plan must include reasonable and time-framed activities which demonstrate that, within 120 days of award, all proposed sites noted on Form 5B:

Service Sites will have the necessary staff and providers in place to begin operating and delivering services as described on Forms 5A: Services Provided and 5C: Other Activities/Locations. In addition, the plan must demonstrate that the health center will be compliant with Health Center Program requirements within 120 days of award.

5) Describe the proposed service delivery sites17 and how the sites ensure availability, prompt accessibility, and continuity of services (consistent with Forms 5A: Services Provided and 5C: Other Activities/Locations) within the proposed service area relative to where the target population lives and works (e.g., areas immediately accessible to public housing for health centers targeting residents of public housing).

Specifically address:

a) Site address(es) and location(s) where services are being/will be provided

(consistent with Forms 5B: Service Sites and 5C: Other Activities/Locations and Attachment 1: Service Area Map and Table). If the site is leased, include relevant portions of the lease or intent to lease documentation in Attachment 14:

Other Relevant Documents.

b) How you will minimize access barriers, including barriers related to the area’s physical characteristics, residential patterns, or economic and social groupings.

c) Distance and duration for patients to travel to or between service sites to access the full range of services proposed.

d) How the total number and type (e.g., fixed site, mobile unit, school-based clinic), hours of operation,…